Examining why smokers do not want behavioral support with stopping smoking

Objective

This article delineates theory-based determinants of the low use of behavioral stop-smoking support with a view to inform interventions to address the low use.

Methods

Study 1 comprised interviews with 27 smokers recruited from a primary care centre in England. Study 2 used a nationwide sample of 212 smokers who completed a questionnaire informed by Study 1. Multiple regression and mediation analyses were used in Study 2 to discern the determinants of smokers’ motivation to use behavioral stop-smoking support.

Results

The best predictors of low motivation to use (a) group support, and (b) one-to-one support were expectations that stop-smoking support is ineffective at increasing chances of stopping smoking. In turn, expectations of ineffectiveness were predicted by expectations that both services provide insufficient support, as well as smokers’ low self-efficacy to use them. A negative image of those attending groups was another predictor of group support.

Conclusion

A substantial proportion of smokers hold expectations about stop-smoking support that are unlikely to facilitate motivation to use such support.

Practice implications

Intervention studies are now needed targeting such expectations.     

A randomised controlled trial of lay-led self-management for people with multiple sclerosis

Objective

To determine the impact of the Chronic Disease Self-Management Course (CDSMC) on people with multiple sclerosis (MS).

Methods

2-group, randomised, controlled trial with Intervention Group (IG) and Waiting-List Control Group (WLCG). Additional data were collected from a Comparison Group (CG) who chose not to attend the CDSMC. Participants completed baseline questionnaires; IG participants attended the CDSMC immediately; all participants were assessed at 4-months and 12-months.

Results

216 baseline questionnaires were returned; 73% were female, mean age 51.1 years, mean disease duration 12.0 years. Results showed that the CDSMC had an impact on self-management self-efficacy (ES 0.30, p = 0.009 for the IG) and MSIS physical status (ES 0.12 for the IG, p = 0.005). There were no other statistically significant changes. However, trends towards improvement on depression (ES 0.21 for the IG, p = 0.05) and MS self-efficacy (ES 0.16 for the IG, p = 0.04) were noted. All improvements were maintained at 12-months. At baseline, CG participants were older, had longer disease duration (p < 0.01) and less anxiety (p = 0.009) compared to RCT participants.

Conclusion

The CDSMC provides some small positive effects for people with MS. Motivation to attend may be linked to psychological distress and disease duration.

Practice implications

The CDSMC may be of value for those with mild anxiety/depression who need extra support. Attendance early in the disease course is recommended.     

Optimizing patient education for people with obesity: Possible use of the autobiographical approach

Objective

To review recent results of the current approaches to the education of obese people, focusing on the motivation for healthy behaviors, and to present the narrative-autobiographical approach as a possible tool in the education of obese people.

Methods

Our overview will necessarily be partial, and limited to some studies that succeeded in improving the motivation for healthy lifestyles in people with overweight or obesity. We will also describe the use of the autobiographical approach in the “Io-muovo-la-mia-vita” project.

Results

Many studies have induced relevant behavioral changes, mainly by using intensive interventions. Weight loss maintenance has been difficult and usually has required pro-active follow-up interventions. The use of self-writing may allow overweight and obese people to reveal their inner feelings to themselves and to peers, and may reinforce their motivation for self-care.

Conclusions

The association of weight loss with intensive interventions, and the need for follow-up pro-active interventions to maintain results make one wonder whether the inner motivation of participants is usually fostered as recommended.

Practice implications

The narrative-autobiographical approach appears to be a proper way to patient centered care, but for an effective practice, the human and relational attitudes of healthcare professionals should be integrated with specific educational skills.     

Initial weight loss is the best predictor for success in obesity treatment and sociodemographic liabilities increase risk for drop-out

Objective

To identify pre-treatment factors related to weight loss in obesity treatment.

Methods

Weight-related and psychological factors were tested in relation to three different weight loss phases: spontaneous weight loss after screening visit (Pre-treatment), weight loss after a preparatory 5-week series of lectures (Step I) and after group treatment lasting two semesters (Step II) in 247 obesity patients.

Results

The strongest factor for predicting weight loss in the Step II treatment was initial Step I weight loss. At least 1 kg weight loss in Step I predicted 13% of the variation in Step II weight loss. Spontaneous pre-treatment weight loss after screening and a history of more weight losses were also related to more Step II weight loss. Psychological encumbrances such as eating disorders and mental distress were not related to weight loss, neither were self-reported motivation nor weight locus of control. The overall attrition rate was 63% and associated with lower education, being an immigrant, lack of occupation, fewer previous weight losses and higher body dissatisfaction.

Conclusion

Initial weight loss is the most certain factor for predicting treatment outcome.

Practice implication

A treatment design including an introductory phase with a minimum weight loss criterion for continuing treatment is suggested.     

Effectiveness of a patient education intervention in enhancing the self-efficacy of hospitalized patients to recognize and report acute deteriorating conditions

Objective

To develop and pilot test the effectiveness of a patient education intervention in enhancing the self-efficacy of hospitalized patients to recognize and report symptoms of acute deteriorating conditions.

Method

Using cluster randomization, acute care general wards were randomized to the experimental and control groups. 34 patients in the experimental group received a 30-minute patient education intervention on Alert Worsening conditions And Report Early (AWARE) while 33 patients in the control group received the routine care only. Levels of self-efficacy to recognize and report symptoms were measured before and after the intervention.

Results

The level of self-efficacy reported by the experimental group was significantly higher than the control group (p < 0.0001).

Conclusion

The AWARE intervention was effective in enhancing the self-efficacy of hospitalized patients to recognize and report acute deteriorating conditions.

Practical implications

Patient engagement through patient education could be included in the rapid response system which aims to reduce hospital mortality and cardiac arrest rates in the general wards.     

Long-term effect of communication training on the relationship between physicians’ self-efficacy and performance

Objective

To examine the long term impact of a communication skills intervention on physicians’ communication self-efficacy and the relationship between reported self-efficacy and actual performance.

Methods

62 hospital physicians were exposed to a 20-h communication skills course according to the Four Habits patient-centered approach in a crossover randomized trial. Encounters with real patients before and after the intervention (mean 154 days) were videotaped, for evaluation of performance using the Four Habits Coding Scheme. Participants completed a questionnaire about communication skills self-efficacy before the course, immediately after the course, and at 3 years follow-up. Change in self-efficacy and the correlations between performance and self-efficacy at baseline and follow-up were assessed.

Results

Communication skills self-efficacy was not correlated to performance at baseline (r = −0.16; p = 0.22). The association changed significantly (p = 0.01) and was positive at follow-up (r = 0.336, p = 0.042). The self-efficacy increased significantly (effect size d = 0.27). High performance after the course and low self-efficacy before the course were associated with larger increase in communication skills self-efficacy.

Conclusion

A communication skills course led to improved communication skills self-efficacy more than 3 years later, and introduced a positive association between communication skills self-efficacy and performance not present at baseline.

Practice implications

Communication skills training enhances physicians’ insight in own performance.     

Does motivational interviewing counseling time influence HIV-positive persons’ self-efficacy to practice safer sex?

Objective

This study examined the impact of motivational interviewing (MI) counseling time on self-efficacy to practice safer sex for people living with HIV/AIDS (PLWHA).

Methods

In 4 month intervals we followed a cohort of 490 PLWHA for 12 months.We conducted hierarchical linear regression models to examine changes in safer sex self-efficacy when participants received zero, low to moderate (5–131 min) and high (132–320 min) doses of MI time. We conducted a similar analysis using number of counseling sessions as the predictor variable.

Results

Participants with low to moderate doses of MI counseling had 0.26 higher self-efficacy scores than participants with zero MI time (p = 0.01). Also, they had 0.26 lower self-efficacy scores than participants with high amounts of MI time (p = 0.04). Participants with high doses of MI had a 0.5 higher self-efficacy score than participants with zero amount of MI time (p < 0.0001). Participants who received 3–4 counseling sessions had 0.41 greater self-efficacy scores than participants who did not receive any sessions (p < 0.0001) but did not differ from participants receiving 1–2 sessions.

Conclusion

MI time is a key to enhancing safer sex self-efficacy among PLWHA.

Practice implications

Safer sex self-efficacy improves the more MI counseling time and sessions PLWHA receive.     

Impact of health literacy on outcomes and effectiveness of an educational intervention in patients with chronic diseases

Objective

Study impact of health literacy on educational intervention for patients “Living with Coronary Artery Disease.”

Methods

187 patients were randomized to: VHS/DVD plus printed booklet; or booklet alone prior to scheduled visit. Main outcome measures included CAD knowledge assessment, clinical outcomes (weigh and blood pressure) and health behaviors (diet, exercise, and smoking); while functional health literacy was assessed as a possible predictor variable.

Results

Knowledge scores and health behaviors improved following both interventions. Those receiving the booklet and video also had a significant improvement in exercise, and weight loss. There was a trend (p = 0.07) towards greater improvement in test scores among those receiving the booklet plus video. Patients with lower health literacy benefited as much as higher literacy patients.

Conclusions

Incorporation of an educational program into clinical visits for patients with chronic disease improved disease-specific knowledge and prompted patients to become activated and involved in their care, improving health behaviors and outcomes. Lower health literacy was not a barrier to this beneficial effect.

Practice implications

Patients with lower health literacy may also benefit from educational, shared decision-making interventions.     

Arm span increases predictive value of models for prevalent vertebral deformities: The Japanese Population-based Osteoporosis (JPOS) Study

Objective

We examined anthropometric indicators to improve predictive ability of asymptomatic vertebral fracture screening models.

Study design and setting

Data were obtained from the 1996 Japanese Population-based Osteoporosis (JPOS) Study. McCloskey–Kanis criteria diagnosed vertebral deformities on X-ray absorptiometric images in 693 women aged ≥50.The multiple logistic regression model included age, height, weight, postmenopausal status, total hip BMD, and arm span (AS) or sitting height as explanatory variables. Akaike's information criterion (AIC) evaluated model goodness-of-fit.

Results

Age-adjusted AS and sitting height in subjects with and without vertebral deformities were 147.2 ± 0.6 cm and 148.5 ± 0.2 cm (P = 0.055), 78.5 ± 0.5 cm and 79.9 ± 0.2 cm (P = 0.007), respectively. Every 5-cm increase in AS indicated 1.5-fold increased risk of prevalent vertebral deformity in the model including age, height, weight, postmenopausal status, and BMD. Including the explanatory variable AS in models yielded better predictive accuracy than excluding AS (AIC, 441.7 vs 446.6, respectively). Sitting height did not significantly influence model predictive ability.

Conclusion

Predictive accuracy of model for vertebral fracture including age, height, weight, postmenopausal status, and BMD improved when AS was added as an explanatory variable. Models to screen for asymptomatic vertebral fractures should include AS.     

Core self-evaluation as a predictor of strength training adoption in older adults

Objective

Progressive resistance training (PRT) counteracts sarcopenia and has been demonstrated to improve physical function and quality of life in older adults. Despite the clear benefits of PRT, participation remains low. The core self-evaluation (CSE) construct is theoretically antecedent to four personality traits: locus of control, self-esteem, neuroticism (emotional stability), and generalized self-efficacy. We have examined the association of CSE with exercise adoption among older adults invited to participate in a PRT trial. We hypothesized that CSE would positively predict adoption of PRT.

Study design

All residents of two retirement communities were invited to complete questionnaires with items on demographics, physical activity, CSE, and general health. Following completion of questionnaires, residents were invited to take part in an on-site, 10-week randomized controlled trial of a PRT-based exercise trial.

Results

Thirty-eight of 358 residents (63.2% women; 76.6 ± 6.1 year; range 58–92) enrolled and 118 residents completed the questionnaires. Multiple regression analysis predicting PRT adoption indicated that the demographic variables accounted for 38% of the variance. Inclusion of CSE (β = .405) accounted for an additional 10% of the variance in PRT adoption.

Conclusion

CSE was predictive of PRT adoption in this cohort, adding significantly to the predictive efficacy of known demographic predictors. This is the first study to show that CSE may influence adoption of PRT in any cohort.     

The influence of diabetes psychosocial attributes and self-management practices on change in diabetes status

Objective

To examine the influence of diabetes psychosocial attributes and self-management on glycemic control and diabetes status change.

Methods

Using data from the Health and Retirement Study, a nationally representative longitudinal study of U.S. adults >51 years, we examined cross-sectional relationships among diabetes psychosocial attributes (self-efficacy, risk awareness, care understanding, prioritization of diabetes, and emotional distress), self-management ratings, and glycemic control. We then explored whether self-management ratings and psychosocial attributes in 2003 predicted change in diabetes status in 2004.

Results

In multivariate analyses (N = 1834), all diabetes psychosocial attributes were associated with self-management ratings, with self-efficacy and diabetes distress having the strongest relationships (adj coeff = 8.1, p < 0.01 and −4.1, p < 0.01, respectively). Lower self-management ratings in 2003 were associated cross-sectionally with higher hemoglobin A1C (adj coeff = 0.16, p < 0.01), and with perceived worsening diabetes status in 2004 (adj OR = 1.36, p < 0.05), with much of this latter relationship explained by diabetes distress.

Conclusion

Psychosocial attributes, most notably diabetes-related emotional distress, contribute to difficulty with diabetes self-management, poor glycemic control, and worsening diabetes status over time.

Practice implications

Self-management and adherence interventions should target psychosocial attributes such as disease-related emotional distress.     

The effect of an educational programme consisting of group and individual arthritis education for patients with polyarthritis--a randomised controlled trial

Objective

The aim of this study was to investigate the effect of an educational programme for patients with polyarthritis compared to usual care.

Methods

Patients with rheumatoid arthritis, psoriatic arthritis and unspecified polyarthritis were randomised to the intervention (n = 71) or usual care (n = 70). The intervention consisted of three group educational sessions followed by one individual educational session. The primary outcomes were a patient's global well-being and arthritis self-efficacy. Secondary outcomes were patient activation, physical and psychological health status, educational needs and disease activity.

Results

After four months the intervention group had significantly better global well-being, 95% CI (2.3–14.1), p = 0.01, and self-efficacy, 95% CI (0.2–8.1), p = 0.04, than the control group. There were also trends for improved disease activity, and a statistically significant improvement in patient activation and pain in the intervention group.

Conclusion

This patient educational programme consisting of group sessions and nurse-delivered individual education has statistically significant benefits for global well-being and maintaining a level of self-efficacy in managing other symptoms in patients with polyarthritis.

Practice implications

This educational programme allows patients to learn from each other in addition to addressing individual educational needs.     

Motivation to quit smoking among parents of urban children with asthma

Objective

To identify factors associated with motivation to quit smoking among parents of urban children with asthma.

Methods

We analyzed data from parents who smoke and had a child enrolled in the School-Based Asthma Therapy (SBAT) trial. We assessed asthma symptoms, children's cotinine, and parent smoking behaviors. Motivation to quit smoking was assessed by a 10-point continuous measure (1, not at all motivated; 10, very motivated).

Results

209 parents smoked (39% of sample), and children's mean cotinine was 2.48 ng/ml. Motivation to quit was on average 6.9, and 47% of parents scored ≥8 on the scale. Parents who believed their child's asthma was not under good control, and parents who strongly agreed their child's asthma symptoms would decrease if they stop smoking had higher motivation to quit compared to their counterparts (p < .05). In a multivariate analysis, parents who believed their child's asthma was not under control had more than twice the odds of reporting high motivation to quit.

Conclusion

Parents’ perception of the risks of smoking to their child with asthma is associated with motivation to quit.

Practice implications

Raising awareness about the effect of smoking and quitting on children's asthma might increase motivation to quit among parents.     

Weight loss strategies: Association with consumption of sugary beverages,snacks and values about food purchases

Objective

To examine whether weight loss strategies are associated with consumption of sugar-sweetened beverages (SSBs), snacks or food values.

Methods

Cross-sectional analysis of 24-h dietary recall data obtained from the National Health and Nutrition Examination Survey 2007–2010 (N = 9440).

Results

Adults trying to lose weight consumed roughly 2000 total calories, 250 calories from SSBs, 225 calories from salty snacks, and 350 calories from sweet snacks. Adults not trying to lose weight consumed roughly 2300 total calories, 300 calories from SSBs, 250 calories from salty snacks, and 380 calories from sweet snacks. While overweight and obese adults trying to lose weight consumed fewer calories than those who were not, heavier adults trying to lose weight using dietary strategies or a combination of diet and physical activity consumed more calories than healthy weight adults using that same weight loss strategy (p < 0.05). Price (>70%) and nutrition (>50%) were most when making food choices (p < 0.05) for all groups.

Conclusion

Consumption of discretionary calories is high regardless of body weight or weight loss intention.

Practice implications

Promoting reduced SSB and snack consumption in the clinical setting may be important for weight loss, particularly among heavier individuals. Clinicians should consider values related to food purchasing to identify concrete behavioral targets.     

Further validation of the 5-item Perceived Efficacy in Patient-Physician Interactions (PEPPI-5) scale in patients with osteoarthritis

Objective

To examine the structural validity, internal consistency, test–retest reliability, and construct validity of the 5-item Perceived Efficacy in Patient–Physician Interactions (PEPPI-5) scale in patients with osteoarthritis (OA).

Methods

A cross-sectional sample of 224 outpatients with OA completed a survey containing the Dutch PEPPI-5 and other standardized measures assessing perceived health-management skills, general self-efficacy, social support, and health-related quality of life. A subsample of 100 patients completed the PEPPI-5 again approximately 3 weeks later.

Results

Confirmatory factor analysis demonstrated good fit for a unidimensional model of the PEPPI-5. Additionally, the scale showed high internal consistency (α = 0.92) and fair test–retest reliability (ICC = 0.68). As hypothesized, the PEPPI-5 was strongly correlated with perceived health-management skills, moderately with social support and psychosocial aspects of health, and not with physical aspects of health. Contrary to expectations, however, it was not correlated with general self-efficacy.

Conclusion

The Dutch PEPPI-5 demonstrated adequate validity and reliability in patients with OA.

Practice implications

The PEPPI-5 is a brief and appropriate tool for measuring self-efficacy of patients with OA to interact with their physicians. Additional research into its sensitivity to change is needed before it can be confidently recommended as an outcome measure in intervention studies.     

Linking numeracy and asthma-related quality of life

Objective

To examine the correlation of numerical skills used in patients’ self-management of asthma with asthma-related quality of life (AQOL).

Methods

Adults with moderate–severe asthma completed the Asthma Numeracy Questionnaire (ANQ), assessments of reading comprehension and self-efficacy, and the mini-Asthma Quality of Life Questionnaire (miniAQLQ). The numeracy-AQOL relationship was evaluated in the context of potential confounders (demographic variables) and mediators (e.g. income and self-efficacy), using tests of correlation then multivariable models to assess for confounders and mediators.

Results

80 adults with moderate or severe asthma were evaluated. Mean ANQ score was 2.3 ± 1.2 (range 0–4). ANQ was correlated with miniAQLQ (ρ = 0.24, p = 0.03). This association was sustained (ρ = 0.27, p = 0.02) when controlling for potential confounders significantly associated with AQOL (age, Latino ethnicity). The ANQ-miniAQLQ association was mediated by household income; the correlation was reduced by 81% when adjusting for income (ρ = 0.05, p = 0.65). In contrast, self-efficacy less strongly mediated this association; the correlation was reduced by 26% when controlled for self-efficacy (ρ = 0.20, p = 0.08).

Conclusion

Numerical skills needed for asthma self-management influence AQOL primarily through their impact on income and, to a lesser extent, on self-efficacy.

Practice implications

Adults with asthma will benefit from self-management instructions employing the simplest mathematical constructs whose understanding is confirmed by clinicians.     

Bone loss during menopausal transition among southern Chinese women

Objectives

Estrogen deficiency during menopausal transition is associated with rapid bone loss. The purpose of this study was to examine the time of onset, the rate, and predictors of menopausal bone loss.

Study design

Prospective data were analyzed from 160 Chinese women between the ages of 45 to 55 years who participated in the Hong Kong Osteoporotic Study.

Main outcome measures

All participants were studied yearly for 4 years. Demographic information, menstrual status according to the Stages of Reproductive Aging Workshop (STRAW), and lifestyle habits were recorded as well as bone mineral density (BMD) measured every visit. Baseline follicular stimulating hormone, sex hormone binding globulin, parathyroid hormones, C-terminal telopeptides of type 1 collagen, estradiol and testosterone were also measured.

Results

There was no significant bone loss at the spine, femoral neck and total hip in premenopausal women. Maximal bone loss occurred within the STRAW stage −2 and −1. Age at menopause, baseline age, body weight and FSH were independent predictors of bone loss. Subjects in the lowest quartile of baseline body weight (<50 kg) lost bone 2 times faster at spine compared with those in the highest quartile (>61 kg). Subjects in the highest quartile of baseline FSH (>40 IU/l) lost bone 1.3–2.3 times faster at all 3 sites compared with those in the lowest quartile (<5.8 IU/l).

Conclusion

Strategies to retard bone loss should be stressed to middle aged women, especially those with lean body built or with early menopause, to prevent osteoporosis later on in life.     

Literacy-appropriate educational materials and brief counseling improve diabetes self-management

Objective

In this pilot study, we evaluated the impact of providing patients with a literacy-appropriate diabetes education guide accompanied by brief counseling designed for use in primary care.

Methods

We provided the Living with Diabetes guide and brief behavior change counseling to 250 English and Spanish speaking patients with type 2 diabetes. Counseling sessions using collaborative goal setting occurred at baseline and by telephone at 2 and 4 weeks. We measured patients’ activation, self-efficacy, diabetes distress, knowledge, and self-care at baseline and 3-month follow-up.

Results

Statistically significant (p ≤ 0.001) and clinically important (effect sizes = 0.29–0.42) improvements were observed in participants’ activation, self-efficacy, diabetes-related distress, self-reported behaviors, and knowledge. Improvements were similar across literacy levels. Spanish speakers experienced both greater improvement in diabetes-related distress and less improvement in self-efficacy levels than English speakers.

Conclusion

A diabetes self-management support package combining literacy-appropriate patient education materials with brief counseling suitable for use in primary care resulted in important short-term health-related psychological and behavioral changes across literacy levels.

Practice implications

Coupling literacy-appropriate education materials with brief counseling in primary care settings may be an effective and efficient strategy for imparting skills necessary for diabetes self-management.     

Web-based self-management support training for health professionals: A pilot study

Objective

To evaluate a web-based self-management training for health professionals. Patients spend 99% of their time outside the healthcare system. Thus self-management support from health professionals is central to optimal care. Our objective was to teach health professionals the skills to provide this support.

Methods

Primary care residents and practicing providers enrolled in six groups. Each group received four web-based interactive training sessions derived from self-efficacy theory. Retrospective-pre/post assessed changes in self-management beliefs and confidence. Wilcoxon signed-rank tests with Bonferroni correction compared responses. Focus groups solicited qualitative feedback.

Results

Fifty-seven residents and providers across the United States enrolled. Residents demonstrated positive changes on all belief questions (P 0.001–0.012). Practicing providers had a non-significant positive change on one and significant changes on the remainder (P 0.001–0.018). Both types of participants demonstrated significant increases on confidence questions regarding their ability to support self-management (P < 0.01 for all). Participants described learned techniques as being useful, reducing burnout, and increasing acceptance of patient involvement in care planning.

Conclusion

The web-based self-management support training for health professionals was feasible and changed beliefs and confidence.

Practice implications

The program may maximize patient self-management by increasing provider self-efficacy and skill for self-management support.     

The cancer information overload (CIO) scale: Establishing predictive and discriminant validity

Objective

Survey data suggests that approximately three-fourths of adults are overwhelmed by cancer information – a construct we label cancer information overload (CIO). A significant limitation of existing research is that it relies on a single-item measure. The objective of the current study is to develop and validate a multi-item measure of CIO.

Methods

Study 1 (N = 209) surveyed healthcare and manufacturing employees at eight worksites. Colonoscopy insurance claims data were culled eighteen months later to evaluate the predictive validity of CIO. Study 2 (N = 399) surveyed adults at seven shopping malls. CIO and cancer fatalism were measured to examine the properties of the two constructs.

Results

Study 1 identified a reliable 8-item CIO scale that significantly predicted colonoscopy insurance claims 18 months after the initial survey. Study 2 confirmed the factor structure identified in Study 1, and demonstrated that CIO, cancer fatalism about prevention, and cancer fatalism about treatment are best modeled as three distinct constructs.

Conclusion

The perception that there are too many recommendations about cancer prevention to know which ones to follow is an indicator of CIO, a widespread disposition that predicts colon cancer screening and is related to, but distinct from, cancer fatalism.

Practice implications

Many adults exhibit high CIO, a disposition that undermines health efforts. Communication strategies that mitigate CIO are a priority. In the short-term, health care providers and public health professionals should monitor the amount of information provided to patients and the public.